Alcoholism and Alcohol Abuse

Social work’s history in the field of alcoholism and alcohol abuse ranges from providing food, temporary shelter, and the encouragement to practice “temperance” in the early 20th century, to today’s sophisticated treatment approaches involving medication, consumer-driven supportive treatment, abuse group-specific targeted prevention, and inpatient and outpatient treatment of alcoholism along with co-morbid conditions. The field has broadened from specifically addressing chronic alcoholism to also targeting related periodic alcohol abuse (binge drinking), as well as the use of alcohol to self-medicate for other illnesses. In addition, community-awareness prevention efforts have been built upon not only the experience gained in treatment settings, but also from research into the biological basis and social implications.  Increasingly varied treatment approaches have evolved to effectively address alcohol and other substance abuse disorders (SUD) coexisting with behavioral and physical illnesses.

The field of alcoholism was a pioneer in early consumer-driven treatment and advocacy, most noted for its Alcoholics Anonymous network, along with community change efforts such as the Temperance Movement and Prohibition, when alcoholism was seen as an issue of will over impulse. Early advocates addressing the problem of alcoholism endeavored to differentiate alcoholism from mental illness, eventually developing separate national policy and funding streams for these two major behavioral illnesses. Early efforts focused on cognitive behavioral approaches such as recognizing trigger cues that lead to relapse from sobriety. Behavioral manifestations such as depression or hallucinations were seen as derivatives of acute or chronic alcoholism. Gradually, experience with and research into the bio-chemical determinants of behavioral illnesses fostered greater sophistication in treatment mapping and addressing co-morbidities such as alcoholism and anxiety disorders, poly-drug use combined with alcohol abuse, alcoholism and hypertension, and alcoholism and depression.

Today, social work researchers bring to the field of alcoholism our person-in-the-environment perspective to explore the culturally diverse manifestations of the disease, its intergenerational impact, the role and purview of the social work practitioner, its relationship to violent behavior, differential gender response, and more.

A listing of resources and research follows to allow direct access to the cutting-edge research that is burgeoning in the field of alcoholism and alcohol abuse. The list of research abstracts provides an overview of social work research in this field.

RESOURCES
  • Conducting and supporting research in a wide range of scientific areas including genetics, neuroscience, epidemiology, health risks and benefits of alcohol consumption, prevention, and treatment
  • Coordinating and collaborating with other research institutes and federal programs on alcohol-related issues
  • Collaborating with international, national, state, and local institutions, organizations, agencies, and programs engaged in alcohol-related work
  • Translating and disseminating research findings to health care providers, researchers, policymakers, and the public

NIAAA Extramural Research Funding
http://www.niaaa.nih.gov/ResearchInformation/ExtramuralResearch/
The NIAAA Extramural Research Program has issued funding announcements such as the following in areas of interest to social work researchers:
PA-07-071 Secondary Analysis of Existing Alcohol Epidemiology Data (R01), issued 11/06
PA-07-066 Alcohol Use Disorders: Treatment, Services Research, and Recovery (R01), issued 11/06
PA-07-064 Research on Alcohol and HIV/AIDS (R03), issued 11/06
PA-07-063 Research on Alcohol and HIV/AIDS (R21), issued 11/06
PA-07-028 Research on Alcohol and HIV/AIDS (R01), issued 11/06
PA-07-036 Structural Interventions, Alcohol Use, and Risk of HIV/AIDS (R01), issued 11/06
PA-07-006 Structural Interventions, Alcohol Use, and Risk of HIV/AIDS (R03), issued 10/06
PA-07-005 Structural Interventions, Alcohol Use, and Risk of HIV/AIDS (R21), issued 10/06

National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)
http://niaaa.census.gov/
The NESARC was conducted and sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The NESARC is the primary source for information and data on the U.S. population for:
alcohol and drug use;
alcohol and drug abuse and dependence; and
alcohol associated psychiatric and other medical co-morbidities.
NESARC was designed to be a longitudinal survey with its first Wave of interviews fielded in 2001-2002. The second Wave of interviews is planned for 2004-2005. The NESARC is a representative sample of the United States population and 43,093 Americans participated in the first Wave of the survey. During Wave 2, an attempt to re-interview all 43,093 of these respondents will be made. The target population of the NESARC is the non-institutionalized household population, 18 years and older, residing in the United States including the District of Columbia, Alaska, and Hawaii. Additionally the following non-institutional group quarters housing units were included as part of the NESARC sample: boarding houses, rooming houses, non-transient hotels and motels, shelters, facilities for housing workers, college quarters, and group homes. The sample provides estimates for the nation as a whole on topics related to alcohol and drug use, abuse and dependence and their associated disabilities.

Social Work Curriculum on Alcohol Use Disorders
http://pubs.niaaa.nih.gov/publications/Social/main.html
This NIAAA curriculum includes lecture-ready modules developed by top-named experts in alcoholism and social work research to support professional MSW education. Materials include PowerPoint® presentations, handout materials, classroom activities, and accompanying case examples to extend student interaction with the subject matter. Modules can be used individually or as a series and modified to fit specific teaching objectives. The curriculum covers current research in the areas of epidemiology, etiology, prevention, screening, assessment, intervention and motivational interviewing, legal and ethical issues, coordinated care systems, intimate partner violence, adolescence, women, older adults, homelessness, co-morbidity, sexual orientation, refugees and immigrants, ethnicity, disability, and fetal exposure to alcohol.

Interagency Coordinating Committee on Fetal Alcohol Syndrome (ICCFAS)
http://www.niaaa.nih.gov/AboutNIAAA/Interagency/aboutICCFAS.htm
The Interagency Coordinating Committee on Fetal Alcohol Syndrome (ICCFAS) was created in October 1996 in response to recommendations of an expert committee of the Institute of Medicine (IOM). The committee report noted that the responsibility for addressing the many issues relevant to Fetal Alcohol Syndrome (FAS) transcends the mission and resources of any single agency or program and recommended that the National Institute on Alcohol Abuse and Alcoholism (NIAAA) chair an effort to coordinate Federal activities on FAS and other disorders associated with prenatal alcohol exposure. The ICCFAS is chaired by Dr. Kenneth R. Warren, Associate Director for Basic Research, NIAAA. The challenge facing the ICCFAS is to improve communication, cooperation, and collaboration among disciplines that address health, education, developmental disability, research, justice, and social service issues relevant to FAS and related disorders caused by prenatal alcohol exposure.

National Clearinghouse for Alcohol and Drug Information (NCADI)
http://ncadi.samhsa.gov/
The Substance Abuse and Mental Health Services Administration (SAMHSA) National Clearinghouse for Alcohol and Drug Information (NCADI) collects, analyzes, and disseminates data and information as part of its mission to improve the quality and availability of substance abuse prevention, addiction treatment and mental health services in the United States.

Treatment Improvement Protocols (TIPS)
TIPS are best practice guidelines for the treatment of substance abuse provided by the SAMHSA Center for Substance Abuse Treatment (CSAT).  TIP #35, Enhancing Motivation for Change in Substance Abuse Treatment (DHHS Publication # SMA 01-3519),is a recent example of publications available that may be ordered by calling 800-729-6686 or accessed through the National Library of Medicine at http://text.nlm.nih.gov

Alcoholics Anonymous (AA)
http://www.alcoholics-anonymous.org/?Media=PlayFlash
Alcoholics Anonymous® is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking. There are no dues or fees for AA membership; we are self-supporting through our own contributions. AA is not allied with any sect, denomination, politics, organization or institution; does not wish to engage in any controversy, neither endorses nor opposes any causes. AA’s primary purpose is to stay sober and help other alcoholics to achieve sobriety.
(Retrieved from http://www.alcoholics-anonymous.org/en_information_aa.cfm on 12/14/06)

National Association for Children of Alcoholics (NACoA)
http://www.nacoa.org/
NACoA is the national nonprofit 501 (c) 3 membership and affiliate organization working on behalf of children of alcohol and drug dependent parents. NACoA’s mission is to advocate for all children and families affected by alcoholism and other drug dependencies. The organization helps kids hurt by parental alcohol and drug use by
• working to raise public awareness;
• providing leadership in public policy at the national, state, and local levels;
• advocating for appropriate, effective, and accessible education and prevention services; and
• facilitating and advancing professional knowledge and understanding.

National Association of Social Workers (NASW)

  • NASW Standards for Social Work Practice with Clients with Substance Use Disorders

http://www.socialworkers.org/practice/standards/NASWATODStatndards.pdf
Social work is in a unique position to influence the delivery of services to address the acute and chronic needs of this vulnerable population of individuals with substance use disorders (SUDs) and their families. By developing and applying evidence-based approaches that incorporate established interventions and evolving technology based on emerging research findings, social workers can markedly improve treatment services for clients and their families. This approach to service delivery requires that social workers be knowledgeable about the processes of addiction and recovery and that they and their clients develop effective treatment plans together, using existing and emerging resources. Social workers have unique, in-depth knowledge about multidimensional problems and services, and, therefore, are essential to the screening and treatment planning of clients with SUDs. These standards are designed to enhance social workers’ awareness, values, knowledge, skills, and methods of practice across settings.(pp.6-7).

  • ATOD Newsletter

http://www.socialworkers.org/sections/atod/newsletters/0405.pdf
ATOD is the National Association of Social Work’s Section Connection newsletter on
Alcohol, Tobacco & Other Drugs. Membership in NASW is required to access other copies of this publication.

SPECIAL JOURNAL ISSUES

Journal of Studies on Alcohol, (11): Sept. 1993.
http://www.collegedrinkingprevention.gov/SupportingResearch/journalStudiesAlcohol.aspx
This special issue on alcohol and aggression is a compilation of the proceedings of the Symposium on Alcohol and Aggression that was held at the Center of Alcohol Studies at Rutgers University from October 8-9, 1992. The symposium was convened with the aim of bringing together investigators, working in distinct areas of the effects of alcohol on aggression, to present their latest findings, to summarize the current research status of the field, to identify important issues to be addressed, and to promote the interaction of researchers working with human and animal subjects. (Introduction, edited.)

Alcoholism Treatment Quarterly, 20(3/4): 2002.
http://www.haworthpress.com/store/product.asp?sku=J020
ATQ is a “resource for practitioners.”  This special issue includes 17 articles giving a 20-year treatment perspective on alcohol problems in the United States.

REFERENCES

The following references were selected from Social Work Abstracts to give examples of research endeavors during the past 25 years. They demonstrate the evolution of research and practice knowledge expansion from the 1970s to today. Abstracts are grouped according to articles about:

  • Research on alcoholism
  • Family issues related to alcoholism
  • Treatment and intervention

Research on Alcoholism

Assessing social work’s contribution to controlled outcome studies in the alcohol dependence treatment literature.
AU:  Vaughn-M-G; Howard-M-O; Jenson-J-M
SO:  Journal-of-Social-Work-Practice-in-the-Addictions. 4(4): 37-49, 2004.
Alcohol use disorders are among the most prevalent and disabling conditions encountered by social work practitioners. Although a substantial body of research findings has accrued evaluating the effectiveness of available alcohol dependence treatments, few efforts have been made to assess the contribution that social work has made to this database. Thus, this study examined the contribution of social work to the alcohol dependence treatment outcome research literature over the past half-century. Controlled investigations of alcohol dependence treatments published between 1950 and 2000 were analyzed by publication outlet type and primary author’s professional affiliation. Computerized bibliographic searches of medical and social science databases and a manual search of 13 core social work journals to identify controlled studies of alcohol dependence interventions were conducted. Results indicated that researchers affiliated with schools or departments of social work as well as studies contained within core social work journals have contributed little to knowledge development, with respect to controlled studies, in the alcohol dependence treatment literature. Greater social work involvement in chemical dependency research would contribute much to current efforts to promote evidence-based practice and clinical guideline development in this important practice area. (Journal abstract)

Epistemology of the bottle: the social construction of alcoholism and alcoholics in social work literature in the United States between 1950 and 1959.
AU:  McVinney-L-D
SO: Journal-of-Social-Work-Practice-in-the-Addictions. 4(4): 3-35, 2004.
This article examines selected social work literature that has been published in mainstream social work journals in the United States from 1950 to 1959 in order to deconstruct how alcoholism and alcoholics have been historically constructed within the social work profession. The theoretical framework employed is that of social constructionism and deconstruction. The methodology is qualitative research, specifically historical analysis. The findings of this article are discussed for their relevance to social work practice and social work education. (Journal Abstract)

Perception of substance use problems in Asian American communities by Chinese, Indian, and Vietnamese American Youth.
AU:  Lee-M-Y; Law-F-M; Eo-E; Oliver-E
SO: Journal-of-Ethnic-and-Cultural-Diversity-in-Social-Work. 11(3/4): 159-189, 2002.
The study was a cross-sectional survey using a convenience sample of 87 Asian American youth respondents to examine their perceptions of substance use problems in the Asian American community. The authors examined respondents’ perceptions of the severity of substance use problems in the Asian American community, perceived characteristics of persons with problems of substance use, perceived etiology of substance use problems, beliefs about treatment, perceived help-seeking preferences and helpful services. The youth demonstrated an increased awareness of the severity of substance use problems in the community, although such awareness was more prominent for drinking problems than drug use problems. Respondents showed a positive attitude towards treatment, although such an attitudinal change was not yet accompanied by a change in their behavioral preferences. Findings suggested a tendency for Asian American youth respondents to use personal resources rather than professional help or formal treatment programs in response to substance use problems. In addition, respondents  shared similar “myths” of Asian problem drinkers and drug users. Implications for developing culturally relevant interventions for prevention and treatment as well as future research are discussed. (Journal abstract.)

Improving the old, embracing the new: Implications of alcohol research for future practice.
AU:  Gordis-E
SO:  Social-Work-in-Health-Care. 33(1): 17-41, 2001.
Alcohol research has two important goals. The first of these is to evaluate existing therapies for treating alcoholism. The second, more long term goal is to increase understanding of the biology of alcoholism and to use this understanding to develop new targeted medications to prevent alcohol use problems and to improve treatment outcome. Considerable research progress has been made over the past three decades toward achieving each goal. The careful study of existing therapies and the development of both behavioral strategies and medications, such as naltrexone, have helped improve treatment success. New neuroscience techniques have led to an increased understanding of how alcohol’s actions in the brain are related to the phenomenon of addiction, and new imaging techniques have permitted scientists to study alcohol’s effects on the brain and to link these effects to behavior in ways not even possible just a few years ago. Finally, genetics researchers are using both animal and human genetics techniques to identify the genes that confer vulnerability to alcoholism and developing ways to apply this information to clinical populations. As a result of increased understanding of the biology of alcohol dependence, future clinicians will need to understand not just the traditional behavioral nuances of alcoholism treatment, but the biology of alcohol dependence as well. (Journal abstract.)

Alcoholism in the families of origin of MSW students: Estimating the prevalence of mental health problems using standardized measures.
AU:  Hawkins-C-A; Hawkins-R-C-II
SO:  Journal-of-Social-Work-Education. 32(1): 127-34, Winter 1996.
Previous research showing that roughly half of social work students report a history of familial alcohol abuse–and proposing that such abuse might affect these students’ current mental health and professional performance –relied on self-reports without standardized screening measures. This 1991 study, based on a convenience sample of 136 MSW students at the University of Texas at Austin, determined students’ status as Adult Children of Alcoholics (ACAs) by self-reports and scores on the Children of Alcoholics’ Screening Test, and evaluated related mental health functioning with four standardized measures. The results suggest that well under half of social work students are ACAs, and that not all (nor only) ACAs were vulnerable to mental health problems. (Journal abstract, edited.)

Development and validation of an adult children of alcoholics tool.
AU:  Hawkins-C-A; Hawkins-R-C-II
SO:  Research-on-Social-Work-Practice. 5(3): 317-39, July 1995.
The authors describe the development and validation of a 25-item Adult Children of Alcoholics Tool (ACAT) in three separate studies: (1) the ACAT was administered to a normative student sample and a clinical outpatient sample to develop a scale with satisfactory reliability and criterion validity; (2) these findings were replicated with a sample of social work students and another clinical sample, providing further construct validation with other measures of current mental health functioning (e.g. depression, internalized shame), and family of origin characteristics; (3) using a third student sample, the ACAT was found to be significantly correlated with the Adult Children of Alcoholics Index, suggesting measurement of a similar but not identical construct. The study discusses the implications of using the ACAT in social work practice as a measure of internalized negative attributes associated with familial alcoholism, particularly, the need to determine the cross-cultural generalizability of the “adult children of alcoholics” syndrome. (Journal abstract.)

Cluster analysis of MMPI profiles of adolescents in treatment for substance abuse.
AU:  Massey-R-F; Walfish-S; Krone-A
SO:  Journal-of-Adolescent-Chemical-Dependency. 2(2): 23-33, 1992.
Previous research has cluster analyzed Minnesota Multiphasic Personality Inventory (MMPI) profiles of adult substance abusers, particularly alcoholics. This is the first study to cluster analyze MMPI profiles of adolescent substance abusers (n = 250). Three clusters were found that
were characterized by: (1) an apparently high level of psychopathology; (2) an impulsive, acting-out style; and (3) a lack of marked psychopathology (no clinically significant elevations). The three clusters were validated by differences between the subjects on seven variables. These results are discussed in relation to previous cluster analyses of MMPI profiles of adult substance abusers, primarily alcoholics. Etiology of psychopathology in adolescent substance abusers and treatment recommendations are made based on the observed clusters. (Journal abstract.)

The utilization of student research and Gestalt organization theory in the development of alcoholism and substance abuse curriculum.
AU:  Goldstein-M-L
DA:  City Univ. of New York, DSW, Feb. 1991.
Problems related to alcohol and other drugs are so pervasive that as many as 50 percent of all social work clients are affected by their consequences. Social work students, therefore, need to be exposed to a curriculum that focuses on policy, practice, and research issues in the chemical dependency field. A study was designed to examine curriculum development in a school of social welfare, using the results of student research as well as Gestalt organizational theory in organizing curriculum change. The study includes an analysis of quantitative data related to students’ histories and backgrounds as well as their attitudes, values, and knowledge of chemical dependency issues. The thesis also includes suggestions and strategies for the development of chemical dependency curricula in other social work educational settings, including charts,   “tests,” and a rich set of bibliographies on alcohol and drugs.

A short-term scale to measure alcohol abuse.
AU:  MacNeil-G
SO:  Research-on-Social-Practice. 1(1): 68-75, Jan. 1991.
Reported are the findings of a study undertaken to validate partially a new short-form scale, the Index of Alcohol Involvement (IAI), that was designed to measure the degree or magnitude of alcohol abuse. The purpose of the discussion is to provide a description of basic psychometric  characteristics of the IAI and to provide guidelines for administration and scoring. (Journal abstract, edited.)

Attitudes of alcohol/substance abuse practitioners toward utilizing computer-based information and communication systems in practice.
AU:  Zysman-S-H
DA:  Adelphi Univ., DSW Dissertation, Mar. 1989.
A descriptive study examined the attitudes of alcohol and substance abuse practitioners toward applying computer-based information and communication systems in practice. A review of the development of computer-based technology in health care and concerns regarding its implementation is provided, along with a discussion of the public policy that inspired the use of computers in treating alcohol and substance abusers. A self -administered questionnaire was completed by 110 alcohol/substance abuse practitioners from 20 agencies in the New York City area. Eight independent variables were tested; two of the variables, years of professional experience and practitioners’ perception of the adequacy of their communication systems, were found to be statistically significant. Practitioners’ attitudes were neutral but leaned toward a favorable attitude concerning use of computers in clinical practice. Implications for social work practice, education, and policy are discussed, and recommendations are offered for future research.

A tool for assessing alcohol misuse in adolescence.
AU:  Robertson-J-F
SO:  Social-Work. 34(1): 39-44, Jan. 1989.
The number of youths with social and personal problems related to alcohol abuse is increasing, and without responsible intervention, serious life problems will result for a significant portion of them. Social workers must be able to assess the extent of adolescent alcohol involvement. A  study discusses the value of using a modified version of the Adolescent Alcohol Involvement Scale (AAIS) as a screening tool which, when used in conjunction with a detailed social history, can assess alcohol involvement and especially alcohol misuse. The items contained in the assessment tool and a description of procedures for its use are presented. The AAIS has been tested on clinical and random samples with better-than-average results, and is recommended for practitioner use because it is simple to use, takes little time to administer, and can be used for research. Suggestions are offered for social workers using the tool to assess the drinking behavior of adolescents. (Journal abstract, edited.)

Primary and secondary alcoholic women.
AU:  Turnbull-J-E
SO:  Social-Casework. 69(5): 290-97, May 1988.
An extensive research literature documents the existence of primary and secondary alcoholism in women, but scant attention has been paid to assessment and treatment issues. The term “primary alcoholism” describes women who present with a history of alcohol abuse in the absence of any pre-existing psychiatric disturbance; “secondary alcoholism” describes women whose alcoholism follows a psychiatric problem, most notably depression. Based on the research literature, a study addresses the complex assessment issues and treatment implications that stem from distinguishing these two groups of women. Clinical and psychosocial characteristics and assessment and treatment strategies are also presented. (Author abstract, edited.)

Benefits of sequential assessment.
AU:  Skinner-H-A
SO:  Social-Work-Research-and-Abstracts. 17(1): 21-28, 1981.
Social workers attempting to assess whether a client has a particular problem may often find themselves operating under constraints having to do with both time and money. Assessments of different degrees of complexity may therefore be needed in different contexts. This study explores the benefits of a model of three stages or levels of assessment and focuses on the use of the model with individuals who had problems with excessive drinking or drug abuse. Specifically, a comparison was made by asking a few simple questions, administering a single scale (Michigan Alcoholism Screening Test), and administering a multidimensional inventory (Alcohol Use Inventory). The sample consisted of 327 clients at a specialized treatment center for addictions. (Journal abstract, edited.)

Family Issues

Two strikes against them? Exploring the influence of a history of poverty and growing up in an alcoholic family on alcohol problems and income.
AU:  Kost-K-A; Smyth-N-J
SO:  Journal-of-Social-Service-Research. 28(4): 23-52, 2002.
The relationship between poverty and substance abuse is complex and mitigated by many factors. While poverty is a risk factor for adolescent substance abuse, there is little research documenting the relationship beyond adolescence. Using a systematic sample of 1,268 cases from the National Longitudinal Survey of Youth, this study investigated whether there are synergistic, intergenerational effects of poverty and alcoholism. Results suggest that a co-occurring history of family alcoholism. Results suggest that a co-occurring history of family alcoholism and poverty has a nonlinear relationship with alcohol problems and income as an adult. Young adults who were poor six or more years and lived with an alcoholic relative for nine or more years are at greater risk of having low income and problems with alcohol as an adult compared to others. Implications for policy, practice, and future research are discussed. (Journal abstract.)

Family therapy in the treatment of alcohol related problems: a review of behavioral family therapy, family systems therapy and treatment matching research.
AU:  Lipps-A-J
SO:  Alcoholism-Treatment-Quarterly. 17(3): 13-23, 1999.
This article reviews the literature for the family therapy of alcoholism. Behavioral family therapy receives the most attention by researchers, but family systems therapy is popular among practitioners. Behavioral family therapy is concerned with altering reinforcement for drinking behavior, and family systems therapy is concerned with family functioning. Although both approaches receive some empirical support, neither approach emerges as superior. Treatment matching attempts to discover the conditions under which treatment approaches are most effective. The author also reviews studies evaluating treatment matching. The most recent study does not support the matching hypothesis, but it is premature to conclude that there is no validity to the theory. Researchers concerned with discovering which interventions work best under what conditions need to replicate prior studies and to formulate and test other matching variables. (Journal abstract, edited.)

Resilience in adult children of alcoholics: a nonpathological approach to social work practice.
AU:  Palmer-N
SO:  Health-and-Social-Work. 22(3): 201-209, Aug. 1997.
Imperative for social work practice is the need to examine practice frameworks that may inadvertently label variations in cultural expression, ways of navigating stress and threat of harm or social oppression, or periods of reassembly in negative or pathological terms. This article  reviews research that explored another way of viewing adult children of alcoholics (ACOAs), because of the epistemology of pathology that grounds research and practice in the area of alcoholism. Using the Differential Resiliency Model (DRM) developed by the author, the study examines qualitative data to obtain a nonpathological approach to understanding the resilience of ACOAs. The DRM can help practitioners provide more timely and appropriate support and services that complement the survival and growth needs of individuals and families. A case example illustrates the use of the model. (Journal abstract.)

Exploring resiliency in adult children of alcoholics.
AU:  Palmer-N
DA:  Univ. of Kansas, Ph.D. Dissertation, May 1991.
Ten adult children of alcoholics between the ages of 24 and 35 years were interviewed for the study. Qualitative data were examined by the researcher who developed an alternative framework to the disease model of alcoholism. This organizing structure is called the Differential Resiliency Model. Findings challenge popular beliefs that behaviors in the alcoholic home are “pathological,” “sick,” or “deviant.” Rather, these behaviors may be strategic survival responses indicative of creative coping and strengths of family members in response to stress. An implication for social work practice is the need to consider the impact of practice frameworks that may inadvertently label variations in cultural expression, lifestyles, or periods of reassembly, in negative terms. Other practice implications include the need for education about alcoholism and  other systemic forces, within and outside of the family, that effect the ability of persons to survive, grow, or thrive. Further areas for research are suggested.

Pathogenic and protective relations in alcoholic families: (I) development of the ritual invasion scale.
AU:  Hawkins-C-A
SO:  Journal-of-Family-Social-Work. 1(4): 39-49, 1996.
Family of origin daily routines and celebratory rituals may serve to protect offspring from the harmful effects of parental drinking. However, parental alcoholism may disrupt these positive rituals, and this “invasion” has been proposed as a mechanism for transmitting risk to offspring. This paper describes the development of a “Ritual Invasion Scale” which may facilitate research and treatment applications with these families. (Journal abstract.)

Family dynamics and individual characteristics of adult children of alcoholics: an empirical analysis.
AU:  Sheridan-M-J; Green-R-G
SO:  Journal-of-Social-Service-Research. 17(1/2): 73-97, 1993.
This study investigates differences in family dynamics and individual characteristics among: (1) adult children of alcoholics receiving professional and self-help recovery services; (2) adult children of alcoholics not receiving such recovery services; and (3) adults from families where there was an absence of substance abuse, domestic violence, incest, and chronic psychiatric or physical problems. Using discriminant analysis, two family variables (family competence and family cohesion) and three individual variables (individuation from parents, control issues expressed through feelings, and problems with self-esteem) were identified as best discriminating between the three groups. Classification analysis revealed that although the identified variables predicted a relatively high percentage of correct classification of the overall sample (69.05 percent), the most accurate prediction of group membership was at the extreme levels of family and individual functioning (either high or low). Implications for practice with alcoholic families and future research are discussed. (Journal abstract.)

Children of alcoholics: a 20-year longitudinal study.
AU:  Miller-D; Jang-M
SO:  Social-Work-Research-and-Abstracts. 13(4): 23-29, 1977.
Presented are the findings of a 20-year study of children from lower-class multiproblem urban families, some of whose parents were alcoholics. The study found that although the parents’ alcoholism increased the problems of these already troubled children and increased the likelihood that they would grow up to have drinking problems themselves, it is not possible to predict the child’s future adjustment solely from the parent’s alcoholism. (Journal abstract, edited.)

Treatment and Interventions

Factors affecting entry into substance abuse treatment: gender differences among alcohol-dependent Alaska Natives.
AU:  Parks-C-A; Hesselbrock-M-N; Hesselbrock-V-M; Segal-B
SO:  Social-Work-Research. 27(3): 151-161, Sept. 2003.
This article reports the results of an investigation of alcohol treatment among Alaska Natives admitted to treatment in Anchorage, Alaska. The time between the age at which they were diagnosed as alcohol dependent and first treatment was similar for men and women. Women were more likely to be parents and reported more contact with health and mental health providers, but these factors were not associated with elapsed time to alcoholism treatment; type of health care professional consulted about problems was associated with elapsed time to treatment for women. Among men, acting as a parent, lifetime depression, and type of professional consulted were significantly associated with elapsed time to treatment. The effect of lifetime depression and parenting on elapsed time to treatment for men raises important questions about the significance of these two factors among other racial and ethnic groups. (Journal abstract.)

Integrating pharmacotherapy and psychosocial interventions in the treatment of individuals with alcohol problems.
AU:  Zweben-A
SO:  Journal-of-Social-Work-Practice-in-the-Additions. 1(3): 65-80, 2001.
Both research and clinical experiences suggest that there are separate and overlapping benefits of medications and psychosocial treatments for alcohol problems. Evidence has shown that medications(s) combined with a moderate intensity psychosocial therapy can produce outcomes beyond what each of these approaches can produce alone. Taking medication can be helpful in facilitating longer periods of abstinence that in turn affords practitioners a greater opportunity to enhance patients’ individual and social coping resources and to increase their motivation to change. Combining effective pharmacological and psychosocial interventions may provide the impetus to integrate alcoholism treatment into the general health care delivery system, thereby helping to increase the accessibility of care and well-being for individuals seeking or needing help with alcohol problems. (Journal abstract.)

A test of a model with reciprocal effects between religiosity and various forms of delinquency using 2-stage least squares regression.
AU:  Benda-B-B; Corwyn-R-F
SO:  Journal-of-Social-Service-Research. 22(3): 27-52, 1997.
This was a study of 1,093 adolescents from six different public high schools, where the same integrated theoretical model of control and social learning theories fit the data on alcohol use, heavy alcohol consumption, use of marijuana, criminal behavior, sexual exploration, and suicidal thoughts. It was observed that the model explained significantly more variance in some of these forms of delinquency than in others, indicating only equivocal support for the deviance syndrome argument in the literature. This study also found that religiosity was a significant influence only on criminal behavior, whereas the feedback effect of delinquency on religiosity was significant for all forms of delinquent behavior studied. The importance of this particular finding was discussed in relation to previous studies, since almost all prior research has used statistics that do not consider reciprocal effects. In the present study, the reciprocal effects between religiosity and various forms of delinquency were analyzed with two-stage least squares regression. (Journal abstract.)

An experimental study of brief unilateral intervention for the partners of heavy drinkers.
AU:  Barber-J-G; Gilbertson-R
SO:  Research-on-Social-Work-Practice. 6(3): 325-36, July 1996.
This study reports on a controlled field experiment in the effectiveness of a brief unilateral intervention for the partners of heavy drinkers. Forty-five women and three men whose partners were both dependent on alcohol and highly resistant to change were randomly allocated to four experimental conditions: (1) unilateral intervention on an individual basis, (2) unilateral intervention within a group, (3) a no-treatment waiting list, and (4) traditional Al-Anon groups. Results revealed that both forms of the unilateral intervention which is referred to as Pressures to Change, were successful in promoting change in the drinker, whereas neither of the alternatives was. However, only when Pressures to Change was offered on an individual basis did the client her- or himself report reductions in personal problems. Similar reductions were also reported by Al-Anon participants. Individual Pressures to Change was also the only intervention to produce improvements in marital consensus. The need for longitudinal research into partner interventions is identified. (Journal abstract, edited.)

Coping strategies and the maintenance of change after inpatient alcoholism treatment.
AU:  Wunschel-S-M; Rohsenow-D-J; Norcross-J-C; Monti-P-M
SO:  Social-Work-Research-and-Abstracts. 29(4): 18-22, Dec. 1993.
The relationship between coping behaviors and maintenance of change after substance abuse treatment is explored in a study of 33 alcoholic men. Coping strategies reported at six-months follow-up were compared with amount of alcohol used during the follow-up period. The study predicted that the more action-oriented, positive, and specific coping strategies would be associated with greater success. Results indicated that relapsers were more likely to keep to themselves and use wishful thinking as coping strategies. Abstainers maintained a positive focus to cope with urges to drink more often than relapsers. Alcoholic people who used behavioral substitution (counter-conditioning) to cope with urges to drink drank significantly less. Implications for treatment planning and for enhancing maintenance are discussed. (Journal abstract.)

Social learning variables in preventing adolescent drinking and driving: implications for school social workers.
AU:  DiBlasio-F-A
SO:  School-Social-Work-Journal. 12(1): 18-25, Fall 1987.
Research suggests that adolescent drinking and driving and willingness to ride with drinking drivers are socially learned and maintained behaviors. A study presents the social learning model and offers specific implications for prevention strategy. From the social learning perspective, driving under the influence (DUI) is first learned through modeling as children observe the DUI behavior of parents and others. In addition, children may develop an evaluative definition of drinking and driving as a normal or justified behavior. Later, the process of differential association with the peer group and modeling of individual peers can encourage or discourage the normative definitions previously formulated within the family group. Differential peer association appears to be the most important variable in the development of DUI; thus, providing adolescents with central roles in the planning and implementation of prevention programs increases the likelihood that peer reinforcement will work in prosocial ways. Converting frequent DUI drivers to peer counselors will not only reduce their own drinking and driving but will also reverse their previous position of reinforcing peers to drink and drive. Creating a normative climate against drinking and driving will influence the convictions and beliefs of youth. In addition, the involvement of parents in prevention programs may offset the negative impact caused by DUI adult models and replace it with positive role models. School social workers can provide the leadership and expertise needed in designing and implementing effective programs.

Changing problem drinkers.
AU:  Finlay-D-G
SO:  Social-Work-Research-and-Abstracts. 13(4): 30-37, 1977.
A study of 34 alcohol-dependent men and women indicated that problem drinkers are more responsive to treatment when they are undergoing a personal crisis brought on by pressure or loss in their social situation. Initial crisis-level anxiety, therefore, approximated a necessary but not sufficient condition for change. In the absence of voluntary change from a heavy-drinking environment to a clearly nondrinking environment, some form of strong pressure from a valued aspect of a problem drinker’s social system had to be present for a marked modification of drinking to occur. The effectiveness of pressure from sources of economic support for inducing change was also noted. Family pressure was insufficient by itself to induce change in behavior–except in the one instance in which the family member held the purse strings. It is apparent that families of problem drinkers typically require a considerable combination of economic,  psychological, and social assistance from helping professionals to make the caring but unequivocal demand for change from the problem drinker, which is a necessary condition for change to take place.

March 24th, 2010 at 10:33 am